A boil is an abscess of the skin caused by an infection of one of the hair follicles located deep in the skin. After a few days, the first development of inflammation - necrosis of the hair follicle and partially surrounding tissues occurs, and gradually a cavity filled with pus (that is, an abscess) forms at this place.
A boil is a common name (synonyms - chiri, chiri). In medicine, this pathology is called the boil, and this is the only correct name for this pathology. Most often it occurs in young people 12-40 years. Most often occur on the face (in 65% of cases), but can also occur on the neck, chest, scalp, groin, back, buttocks ...
Boil has several stages of development. After infection of the hair follicle for several days, there is an increasing infiltration of tissues (Fig. 8). At this time there is still no pus inside the boil. Very often, in the center of the infiltrate (which looks like a red bump on the surface of the skin), you can see the mouth of the hair follicle with the hair shaft protruding from it.
When touching, you can feel that the tissues are strained and sealed, and the touch itself can be painful. After about 3-4 days, a cavity with pus begins to form inside the boil, and necrosis of the hair follicle occurs, which leads to the formation of a necrotic rod. At this stage, one or several white or black dots can be seen on the surface of the boil (Figure 9-10).
Gradually, the amount of pus in the inside of the boil increases, which can lead to its breakthrough (pus will begin to ooze through the formed hole). Gradually, the necrotic rod of the boil will begin to push and tear away. Outwardly, it looks like a horn sticks out. If the rod does not fall out by itself, then it should be removed from the surgeon.
Common symptoms -
moderate body temperature is usually observed, rarely high, sometimes it is completely absent. The pain is usually spontaneous, has a weak intensity. Severe pain can be in cases when a boil is formed in the nose (from the mucous membrane of the nasal passages) or a boil in the ear (when it is formed in the ear canal).
The scheme of the gradual development of boil from the infiltration stage to the formation and rejection of the necrotic rod, and recovery (Fig.11) -
Boil on the face: features of the disease
As a rule, such localization of inflammation leads to the development of significant edema on the face. This is due to the features of the blood supply to the face. It is especially dangerous when a boil occurs on the upper lip, on / in the nose or in the area of the nasolabial folds.
Such localization is fraught with the development of thrombophlebitis of the facial vein and the ingress of infected blood clots into the vascular system of the brain, which can cause life-threatening conditions. Therefore, it is necessary to carry out the treatment of such chiri only at the doctor and in no case try to squeeze them out.
Boil: causes of appearance
In most cases, the development of boil is associated with infection of the hair follicle namely Golden Staphylococcus, less often - White Staphylococcus or Streptococcus. These bacteria are found on the skin of absolutely all healthy people and cause an infection only when they penetrate into the deeper layers of the skin through a scratch, abrasion or cut (for example, when shaving).
Predisposing factors for chiri development -
- poor skin hygiene,
- with weakened immunity,
- if you have diabetes, oncology, rheumatoid arthritis,
- if you have acne (acne and acne),
- in the presence of skin diseases such as psoriasis and eczema,
- with obesity
- if you are taking prednisone or its analogs,
- if you live in a hot, humid climate.
Chiri: treatment at the doctor and at home
Home treatment of chiria is possible (in the cases listed below).
- Can be treated at home -
if the dimensions of the boil is not more than 5 mm and you do not have symptoms of intoxication and elevated temperature. Also, you should not have the disease from the list below.
- It is necessary to consult a doctor -
→ if the boil originated in a baby, a young child,
→ there are symptoms of intoxication, fever,
→ if a boil occurs on the upper lip, nose, nasolabial folds,
→ if there are symptoms of inflammation: for example, an area of reddening of the skin has increased or red stripes have appeared near the chirie, or another boil is formed next to it.
→ in the presence of diseases: diabetes, oncology, reduced immunity, endocarditis or rheumatoid arthritis, there is obesity, you take prednisone (in all these cases, you must not only treat the doctor, but also use antibiotic therapy).
The main methods of treatment -
- wet heat compresses (to accelerate boil ripening),
- surgical treatment (incision and drainage).
1. Use heat packs
Wet heat packs are needed to speed up the boil ripening process (formation of pus and necrotic rod). Thus, an abscess dissection and pus discharge will occur faster. Such compresses are carried out several times a day for 15-20 minutes. On the face such compresses should be carried out with great care and only with the recommendations of the doctor.
Small boils (up to 5 mm), in principle, can be cured only by thermal compresses (without the use of antibiotics). But if you have a fever, you will still need to consult a doctor.
Alternative to wet heat packs -
Vishnevsky ointment (fig.12) has an effect comparable to wet heat compresses. Dressings with it will also increase blood circulation in the area of chiria and accelerate its maturation. Dressings with Vishnevsky's ointment can be made with chirias of any location other than the face. On the face, this is fraught with the development of thrombophlebitis of the facial veins and serious infectious brain damage.
Important: warming compresses are shown during boil (furuncle), but if you make a mistake with the diagnosis, then they can seriously complicate the course of the inflammatory process. For example, Vishnevsky ointment is absolutely contraindicated in case of suppurating lipoma or atheroma, lymphadenitis, carbuncles ...
2. Surgical treatment (necropsy)
A boil can only be opened when it becomes soft (this indicates a formed cavity with pus), and when a necrotic core forms in its center. If within 1.5-2x weeks there was no spontaneous opening and rejection of the necrotic rod, an urgent need to run to the surgeon. If a boil occurs on the face or neck - to a dental surgeon or a maxillofacial surgeon, in other parts of the body - to a general surgeon.
Large boils need to be opened and drained. Taking antibiotics can not replace surgical treatment (if it has indications), because antibiotics practically do not penetrate the wall of an abscess, and affect only the surrounding tissue and general condition.
What to pull out the pus after opening the boil -
warm moist compresses are recommended to be used, including after opening, because they stimulate the discharge of pus and clean the wound. After opening, you can also use ointment dressings with Levomekol (Fig. 14), which helps to clean the wound surface of necrosis and pus.
Important: attempts to open the boil yourself, squeeze it out, cut it will lead to the following consequences -
- increases the risk of scarring on the skin after healing,
- forming another 1-2 chirias in the surrounding tissues,
- development of thrombophlebitis of the facial veins and, as a result, sepsis and even death.
3. Treatment of chiria with antibiotics
Antibiotics are not always prescribed. It is recommended only if the patient has symptoms of intoxication, severe inflammation, if the boil is large, or it is in very sensitive places (inside the nose or ear, in the groin area ...), and also in the presence of previously listed diseases.
- Boil size up to 5 mm, in the absence of temperature -
in this case, antibiotics are not needed (in the absence, of course, of concomitant chronic diseases).
- Boil over 5 mm and low temperature -
antibiotics are effective against Staphylococcus aureus with a course of 5 to 10 days: sulfamethoxazole (trimethoprim), clindamycin, vibromycin, minocycline, doxycycline ...
- With high fever and severe inflammation -
antibiotics in this case are taken at least 10 days. Among the drugs of choice: rifampicin, rimaktan, rifadin ... If a patient has meticellin-resistant strain of Staphylococcus aureus (MRSA), then vancomycin or analogues are prescribed.
Keep in mind that Staphylococcus aureus has a peculiarity to very quickly become insensitive to various antibiotics, so in no case should you engage in self-prescription of antibiotics. Otherwise, in the next case of infection, no one antibiotic can help you. We hope that our article: How to treat boils on the face and body - turned out to be useful to you!
Author: dental surgeon Kamensky KV, 19 years experience.